Responding to and Treating Hallucinations in Lewy Body Dementia

People with Lewy body dementia are more likely to experience hallucinations than those with Alzheimer's or vascular dementia, and in general, they experience them earlier in the disease process than people do with other types of dementia. For some people, these hallucinations may even be one of the first symptoms of Lewy body dementia they experience.

Up to 80% of people with Lewy body dementia experience visual hallucinations. These hallucinations are often recurrent and very detailed. Hallucinations of adults, children or animals are common.

Some research has found a correlation between the presence of hallucinations and an increased amount of cognitive impairment in Lewy body dementia. Hallucinations in LBD have also been associated with a decrease in quality of life; thus, having an awareness of how to respond to them can be very helpful for both the person living with LBD and his caregiver.

Responding to Lewy Body Dementia Hallucinations

It can be difficult to know how best respond to hallucinations in Lewy body dementia. Because these hallucinations often occur earlier in the disease process, some people respond well to gentle reality orientation and reassurances that the hallucination isn't real. Although it's not recommended to try to persuade someone with Alzheimer's disease that what they're seeing or hearing isn't there, in Lewy body dementia, you may want to try that method first since there are usually fewer cognitive deficits in the person with Lewy body dementia when they're experiencing hallucinations.

If your family member directly asks you if you see the person that he sees across the room, experts and family members recommend being truthful and acknowledging that although you don't see her, you know that he does. Family members have told stories about how their loved one with Lewy body dementia caught them in small untruths and became angry and agitated.

If your loved one is very upset and distraught about his hallucination, you will want to use caution and provide some extra space between you and him. In his distress, it's possible he could mistake you for his hallucination or experience a catastrophic reaction and become combative. Reassure him and ask him if you can come sit by him before entering his space.

You can also try using validation therapy and ask him what the person looks like, how long they've been there, and what makes the person go away.

Other options include using distraction by going into a different room or for a walk outside, turning on some music, talking about the football game or calling the dog over to your loved one for some  pet therapy.

Treatment of Hallucinations in Lewy Body Dementia

When someone with Lewy body dementia experiences hallucinations, treatment might follow a similar protocol to treatment of hallucinations in other kinds of dementia with a very important exception: the use of anti-psychotic medications. About half of people with Lewy body dementia are extremely sensitive to typical antipsychotic medications including Haldol and can experience severe and life-threatening reactions to them. Atypical anti-psychotics may be less likely to provoke a serious reaction but caution is very important when considering the use of antipsychotic medications in Lewy body dementia.

It's also important to note that in some people with Lewy body dementia, Sinemet ( carbidopa / levadopa)—a medication that may be prescribed to treat the movement challenges of the disease—can cause or worsen hallucinations in these people.

Research has shown that some people with Lewy body dementia who experience hallucinations have benefited from cholinesterase inhibitors. This class of medication has been approved by the US Food and Drug Administration to treat Alzheimer's disease and is often used for other dementias as well. Cholinesterase inhibitors include the drugs Aricept (donepezil), Exelon (revastigmine) and Razadyne (galantamine).

A Final Word 

Finally, remember that Lewy body dementia, like other dementias, is a disease that affects the whole family. No matter how much you love the person, caring for someone with Lewy body dementia can be very draining on both your physical and emotional energy. If you're running on empty or just at a loss for what to do, consider attending a support group or looking into other ways to provide in-home care or facility care for your loved one.

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